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EP1467681A1 - Endoprothese d'articulation de la hanche et de l'epaule - Google Patents

Endoprothese d'articulation de la hanche et de l'epaule

Info

Publication number
EP1467681A1
EP1467681A1 EP02791820A EP02791820A EP1467681A1 EP 1467681 A1 EP1467681 A1 EP 1467681A1 EP 02791820 A EP02791820 A EP 02791820A EP 02791820 A EP02791820 A EP 02791820A EP 1467681 A1 EP1467681 A1 EP 1467681A1
Authority
EP
European Patent Office
Prior art keywords
shaft
endoprosthesis according
cap
endoprosthesis
head cap
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
EP02791820A
Other languages
German (de)
English (en)
Other versions
EP1467681B1 (fr
Inventor
Wilfried Glien
Frank Dallmann
Dirk Salomon
Lars KÄPPEL
Thomas Oberbach
Thomas Katzer
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Synthes Bettlach GmbH
Original Assignee
Mathys AG Bettlach
Mathys Orthopadie GmbH
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Mathys AG Bettlach, Mathys Orthopadie GmbH filed Critical Mathys AG Bettlach
Publication of EP1467681A1 publication Critical patent/EP1467681A1/fr
Application granted granted Critical
Publication of EP1467681B1 publication Critical patent/EP1467681B1/fr
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3601—Femoral heads ; Femoral endoprostheses for replacing only the epiphyseal or metaphyseal parts of the femur, e.g. endoprosthetic femoral heads or necks directly fixed to the natural femur by internal fixation devices
    • A61F2/3603—Femoral heads ; Femoral endoprostheses for replacing only the epiphyseal or metaphyseal parts of the femur, e.g. endoprosthetic femoral heads or necks directly fixed to the natural femur by internal fixation devices implanted without ablation of the whole natural femoral head
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/40—Joints for shoulders
    • A61F2/4003—Replacing only the epiphyseal or metaphyseal parts of the humerus, i.e. endoprosthesis not comprising an entire humeral shaft
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
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    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/3094—Designing or manufacturing processes
    • A61F2/30965—Reinforcing the prosthesis by embedding particles or fibres during moulding or dipping
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30112—Rounded shapes, e.g. with rounded corners
    • A61F2002/30113—Rounded shapes, e.g. with rounded corners circular
    • A61F2002/30118—Rounded shapes, e.g. with rounded corners circular concentric circles
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
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    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30242—Three-dimensional shapes spherical
    • A61F2002/30245—Partial spheres
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
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    • A61F2002/30291—Three-dimensional shapes spirally-coiled, i.e. having a 2D spiral cross-section
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30332—Conically- or frustoconically-shaped protrusion and recess
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30574—Special structural features of bone or joint prostheses not otherwise provided for with an integral complete or partial collar or flange
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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Definitions

  • the invention relates to a hip and shoulder joint endoprosthesis with a shaft and a calotte which is integral with the shaft or can be fastened to the shaft.
  • the head cap has a curved top and a closed bottom.
  • the shaft and the head cap each have a longitudinal axis and the axis of the head cap runs through the center of the cap and approximately perpendicular to the underside of the cap.
  • Conventional endoprostheses are anchored intramedulally via a shaft pivoted at a certain angle (eg 135 ° ) to the head axis, the shaft having a length of 10 to 20 cm and being inserted into the medullary cavity of the bone.
  • the anchoring mechanism may be over-determined. If the distal tip of the prosthesis is supported intramedu- larly, the natural application of force is diverted away from the proximal cortex in the calotte area and into the intramedular shaft area.
  • No. 4,042,980 shows a humeral component with a short shaft, in which the calotte can be hollow or closed.
  • the shaft has circumferential ribs.
  • DE 42 20 217 AI describes a prosthesis for replacing the surface of the joint, in particular the cartilage layer. Accordingly, the dome is not solid and does not end with a flat surface, but is cap-shaped on the inside except. With such cup prostheses there is a risk of osteolysis
  • the object of the present invention is a hip or shoulder joint endoprosthesis that can be precisely positioned and permanently fixed with simple means.
  • this object is achieved in that the longitudinal axis of the shaft encloses an angle of at most 30 ° with the axis of the spherical cap, that the cone angle of the shaft is 5 ° to 30 ° and that the spherical cap has the shape of a spherical section of less than a hemisphere and that the length of the shaft is less than the diameter of the calotte.
  • the cone angle of the shaft is preferably approximately 20 °
  • the short shaft prosthesis according to the invention is anchored exclusively in the epiphysis, the shaft axis being pivoted by a maximum of 30 °, preferably by a maximum of 20 °, relative to the axis through the center of the calotte.
  • the shaft axis coincides with the axis of the calotte. This avoids overdetermination during anchoring and ensures the application of force across the cortical edge of the resection plane and by means of a press fit in the cancellous bone.
  • the shaft is very short, preferably shorter than the diameter of the calotte. Head cap and shaft can be formed in one part or two parts.
  • the shaft and the spherical cap are separate components that can be connected to one another.
  • the connection can be made by positive locking, for example snap elements, or by positive locking, for example a threaded connection.
  • the connection between the shaft and the spherical cap preferably takes place via a conical shoulder on the shaft and a corresponding conical recess in the spherical cap.
  • the arrangement can also be reversed and the conical attachment can be formed on the calotte and the conical recess in the shaft.
  • a support surface which widens in the form of a disk and which rests on the resection plane is preferably provided.
  • the underside of the calotte or the support surface is closed and can be flat, slightly convex or slightly concave. Particularly when the underside is convex, there is a very homogeneous distribution of the stress from the joint to the cortex and cancellous bone.
  • the shaft tapers preferably conically or over a radius in the direction of the shaft tip. Which is directly on the underside of the calotte or the support
  • the area adjoining the pane can also be cylindrical.
  • the shaft preferably has one or more ribs, which are generally radially around the shaft
  • the shaft can also be prismatic with smooth outer surfaces.
  • the advantages which can be achieved by the invention consist in particular in that the loads emanating from the joint are homogeneously transmitted to the cortex and cancellous bone, so that there is no bone breakdown or reconstruction here. Due to the taper of the shaft with an angle of up to 30 °, preferably about 20 °, a secure fit of the shaft in the cancellous bone is achieved by clamping, which is referred to in the present field as a "press fit".
  • the shaft axis is preferably on the same axis which runs through the center of the calotte perpendicular to the calotte end surface or underside.
  • the support and force application is therefore carried out via the cortical ring in the resection plane and via press fit into the cancellous bone or into the cement holder when cementing.
  • the support of the head over the calotte end surface or the support surface of the shaft on the resection level is flat even after inaccurate resection and shaft seat opening as well as retrotorsion and inclination fluctuations and thus ensures a homogeneous force application close to the preoperative starting situation. This reduces the risk of osteolysis, especially in comparison to surface replacement prostheses with internally recessed, cap-shaped caps.
  • the joint cap of the humerus is completely resected. This creates the necessary space for the care or implantation of the glenoid.
  • the reproduction of the medio-dorsal offset of the calotte to the shaft can be ensured with precise instrumentation when opening the shaft channel.
  • one or more recesses can be provided in the shaft in any arrangement, e.g. axial, radial or inclined milling, bores or elongated holes.
  • Several pins on an outer ring around the shaft axis can contribute to anchoring and absorbing shear forces and securing rotation.
  • the underside of the calotte or support surface is preferably structured, e.g. grooved or porous coated.
  • the shaft part can be made of titanium or cobalt-chrome alloys and the joint head can be made of a cobalt-chrome alloy or ceramic.
  • the shaft part and / or joint head can also be made of plastic, unreinforced or fiber-reinforced.
  • cup prostheses are used as a surface replacement for a damaged joint head.
  • the calotte is generally still relatively well preserved, so that the endoprosthesis is in principle a hemispherical cap that is placed on the joint head. If, on the other hand, the joint head is largely destroyed, a long shaft prosthesis is usually used.
  • the joint endoprosthesis according to the invention is in many cases an alternative to such long shaft prostheses, but also to the short shaft prostheses mentioned with cap-shaped calottes, and represents a concept in shoulder endoprosthetics which has not been implemented in this consequence so far not be waived.
  • FIG. 7 to 10 show an embodiment of a two-part joint endoprosthesis from below, from the side in an exploded state, from the side in the assembled state or in a perspective view;
  • 11 to 14 a second embodiment of a two-part joint endoprosthesis from below, from the side in an exploded state; in the side in the assembled state or in a perspective view;
  • 21 and 22 show an embodiment of the joint endoprosthesis with an angled shaft
  • Fig. 23 shows an embodiment with a grooved bottom of the calotte
  • Fig. 24 in section the implanted joint endoprosthesis. 1 to 3 show a one-piece joint endoprosthesis with a shaft 10 and a calotte 20.
  • the shaft 10 is fluted with four grooves 11, between which ribs 12 each remain.
  • the outer edges of the ribs 12 are slightly concave. Down the ribs taper 12 and ends in a rounded tip 13.
  • the outer edge of each rib '12 extends at an angle of approximately 10 ° to the longitudinal axis of the shank 10.
  • the area of the grooves 11, however, is axially aligned.
  • the spherical cap 20 has a curved upper side 21 and a flat lower side 22 and thus has the overall shape of a spherical section, the spherical section making up less than a hemisphere.
  • the center angle ⁇ is less than 170 °.
  • the transverse dimension of the spherical cap 20 can be, for example, 43 mm and the length of the shaft 10, on the other hand, only 25 mm. Due to the channeling of the shaft 10, the endoprosthesis is secured against rotation. The ribs 12 tapering towards the blunt tip 13 result in a type of press fit of the prosthesis in the cancellous bone (press fit). The underside 22 of the spherical cap 20 sits flat on the resection plane.
  • Figures 4 to 6 also show an embodiment of a one-piece joint endoprosthesis.
  • the surface of the shaft 10 is conical and smooth.
  • the tip 13 is also rounded.
  • the spherical cap 20 in turn has the shape of a spherical section.
  • Four pins 23 protrude from the underside 22 and secure the endoprosthesis against thrust forces and rotation.
  • the pins 23 have a length of approximately 5 to 20 mm, a diameter of approximately 4 to 10 mm and are provided on their surface with grooves or threads and / or coated, as a result of which the pins are better anchored in corresponding holes in the cancellous bone becomes.
  • FIG. 7 to 10 show an exemplary embodiment of a two-part joint endoprosthesis, the shaft 10 and the spherical cap 20 being formed as separate elements which are formed by means of a cone 14 at the upper end of the shaft 10 and a corresponding conical recess 24 in the underside of the spherical cap 20 can be put together.
  • the shaft 10 is composed of an axial pin 15 which tapers with a concave surface towards the blunt tip 13.
  • a support disk 16 is formed which is transverse to the longitudinal axis.
  • four ribs 12 are provided, distributed uniformly over the circumference, the outer edges of which converge at an angle of approximately 20 to 70 °, preferably approximately 6 ⁇ °.
  • FIGS. 11 to 13 show a further embodiment of a two-part joint endoprosthesis.
  • the shaft 10 is fluted in a manner similar to that of the exemplary embodiment in FIGS. 1 to 3.
  • the connection between the shaft 10 and the spherical cap is made, as in the embodiment of FIGS. 7 to 10, by a cone 14 at the upper end of the shaft 10 and a correspondingly conical recess and a spherical cap 20.
  • a support disk 16 is also provided here between the shaft 10 and the cone 14.
  • FIGS. 15 to 18 show the shaft 10 of a two-part joint endoprosthesis similar to that of FIGS. 11 to 14, the shaft 10 being provided with openings 18 of circular or elongated cross section.
  • the openings 18 allow the bone substance to grow in.
  • FIG. 19 and 20 show in section joint endoprostheses with a head cap 20 and a short shaft 10, the underside 22 of the head cap 20 being convex and being flatly conical downwards (FIG. 19) or curved downwards or upwards ( Fig. 20).
  • the spherical cap 20 has an overall lens shape.
  • the convex shape of the underside 22 results in a particularly homogeneous introduction of the forces from the joint to the cortex and cancellous bone.
  • FIGS. 21 and 22 show one-piece joint endoprostheses similar to that of FIGS. 1 to 3, but the shaft 10 is inclined at an angle of approximately 10 ° to the axis of the spherical cap 20. As in the embodiment of FIGS. 7 to 9, the shaft is provided with radial ribs 12. Positioning the shaft 10 at an angle to the calotte 20 can sometimes be expedient to prevent the shaft from touching the cortex opposite the resection plane.
  • FIG. 23 shows an endoprosthesis obliquely from below, in which the underside of the spherical caps 20 has a spiral-shaped groove 25.
  • the groove 25 enables a better ingrowth of the bone.
  • FIG. 24 shows the implanted joint endoprosthesis in section.
  • the flat underside 22 of the spherical cap 20 sits flat on the resection plane R and the shaft extends into the cancellous bone S, its tip keeping a sufficient distance from the cortex K.
  • a narrow area 2 can be seen in FIG. 24, which can be a cement tube or a coating of the endoprosthesis. Such a cement quiver or coating can be present. However, they are not always necessary.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)
  • Ceramic Products (AREA)
  • Pivots And Pivotal Connections (AREA)
EP02791820A 2001-12-14 2002-12-13 Endoprothese d'articulation de la hanche et de l'epaule Expired - Lifetime EP1467681B1 (fr)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
DE20120241U DE20120241U1 (de) 2001-12-14 2001-12-14 Gelenk-Endoprothese
DE20120241U 2001-12-14
PCT/EP2002/014214 WO2003051238A1 (fr) 2001-12-14 2002-12-13 Endoprothese d'articulation de la hanche et de l'epaule

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EP1467681B1 EP1467681B1 (fr) 2008-02-20

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EP (1) EP1467681B1 (fr)
JP (1) JP2005511243A (fr)
AT (1) ATE386480T1 (fr)
AU (1) AU2002358134B2 (fr)
DE (2) DE20120241U1 (fr)
WO (1) WO2003051238A1 (fr)

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EP2502605A1 (fr) 2011-03-25 2012-09-26 Zimmer GmbH Prothèse d'épaule
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Also Published As

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WO2003051238A1 (fr) 2003-06-26
JP2005511243A (ja) 2005-04-28
US20040225367A1 (en) 2004-11-11
EP1467681B1 (fr) 2008-02-20
AU2002358134A1 (en) 2003-06-30
ATE386480T1 (de) 2008-03-15
DE20120241U1 (de) 2003-04-24
AU2002358134B2 (en) 2008-03-20
DE50211754D1 (de) 2008-04-03

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